Zagra Luigi, Maccario Camilla, Mondini Andrea, Bianchi Luca
Hip Department, IRCCS Galeazzi Orthopaedic Institute, Milan - Italy.
Hip Int. 2014 Oct 2;24 Suppl 10:S48-57. doi: 10.5301/hipint.5000170.
Total hip arthroplasty is considered one of the greatest advances in health care of the last century. More than one million THAs are estimated to be performed annually and an increasing number of revisions are expected in the future. Osteolysis and loosening are still the main reasons for failure, justifying the use of low-wear bearings.The aim of this paper is to describe the mode of failure of the different couplings (polyethylene, cross-linked PE, metal, ceramic) and the options of treatment considering the various scenarios that the surgeon has to face nowadays in the case of failure related to articulation material. A comprehensive algorithm of treatment strategies is proposed based on the best current evidence and on the authors' experience.Periodical follow-up, indications for early revision, selection of proper surgical techniques and tribology are suggested. Nowadays, few rules are strongly recommended: trying to avoid any metal in case of failure of metal-on-metal; to avoid metal in fracture of ceramic; never to mix metals or ceramics from different manufactures. We aim to address a great number of open questions. There is still need for further research and evidences in this essential field of orthopaedic surgery.
全髋关节置换术被认为是上个世纪医疗保健领域最伟大的进步之一。据估计，每年进行的全髋关节置换术超过100万例，预计未来翻修手术的数量还会增加。骨溶解和松动仍然是失败的主要原因，这使得低磨损轴承的使用成为合理选择。本文的目的是描述不同关节组合（聚乙烯、交联聚乙烯、金属、陶瓷）的失效模式，以及考虑到外科医生如今在与关节材料相关的失败案例中必须面对的各种情况时的治疗选择。基于当前最佳证据和作者的经验，提出了一种全面的治疗策略算法。建议进行定期随访、早期翻修的指征、选择合适的手术技术以及摩擦学方面的注意事项。如今，强烈推荐几条规则：金属对金属失败时尽量避免任何金属；陶瓷骨折时避免使用金属；绝不要混合不同制造商的金属或陶瓷。我们旨在解决大量未解决的问题。在这个骨科手术的关键领域，仍然需要进一步的研究和证据。
